2012 Coding Updates. Effective January 1, 2012

Transcription

1 2012 Coding Updates Effective January 1, 2012

2 ICD-9 Updates For 2012 Effective October 1, 2011

3 Infectious and Parasitic Diseases Shiga toxin-producing Escherichia coli [E. coli] (STEC) Other specified Shiga toxin-producing Escherichia coli [E. coli] (STEC) Shiga toxin-producing Escherichia coli [E. coli] (STEC), unspecified Other and unspecified Escherichia coli [E. coli]

4 Neoplasms Unspecified malignant neoplasm of skin of lip Basal cell carcinoma of skin of lip Squamous cell carcinoma of skin of lip Other specified malignant neoplasm of skin of lip Unspecified malignant neoplasm of eyelid, including canthus Basal cell carcinoma of eyelid, including canthus

5 Neoplasms Squamous cell carcinoma of eyelid, including canthus Other specified malignant neoplasm of eyelid, including canthus Unspecified malignant neoplasm of skin of ear and external auditory canal Basal cell carcinoma of skin of ear and external auditory canal Squamous cell carcinoma of skin of ear and external auditory canal

6 Neoplasms Other specified malignant neoplasm of skin of ear and external auditory canal Unspecified malignant neoplasm of skin of other unspecified parts of face Basal cell carcinoma of skin of other and unspecified parts of face Squamous cell carcinoma of skin of other and unspecified parts of face Other specified malignant neoplasm of skin of other and unspecified parts of face

7 Neoplasms Unspecified malignant neoplasm of scalp and skin of neck Basal cell carcinoma of scalp and skin of neck Squamous cell carcinoma of scalp and skin of neck Other specified malignant neoplasm of scalp and skin of neck Unspecified malignant neoplasm of skin of trunk, except scrotum

8 Neoplasms Basal cell carcinoma of skin of trunk, except scrotum Squamous cell carcinoma of skin of trunk, except scrotum Other specified malignant neoplasm of skin of trunk, except scrotum Unspecified malignant neoplasm of skin of upper limb, including shoulder Basal cell carcinoma of skin of upper limb, including shoulder

9 Neoplasms Squamous cell carcinoma of skin of upper limb, including shoulder Other specified malignant neoplasm of skin of upper limb, including shoulder Unspecified malignant neoplasm of skin of lower limb, including hip Basal cell carcinoma of skin of lower limb, including hip Squamous cell carcinoma of skin of lower limb, including hip

10 Neoplasms Other specified malignant neoplasm of skin of lower limb, including hip Unspecified malignant neoplasm of other specified sites of skin Basal cell carcinoma of other specified sites of skin Squamous cell carcinoma of other specified sites of skin Other specified malignant neoplasm of other specified sites of skin

11 Neoplasms Unspecified malignant neoplasm of skin, site unspecified Basal cell carcinoma of skin, site unspecified Squamous cell carcinoma of skin, site unspecified Other specified malignant neoplasm of skin, site unspecified

12 Blood and Blood-Forming Organs Thalassemia, unspecified Alpha thalassemia Beta thalassemia Delta-beta thalassemia Thalassemia minor Hemoglobin E-beta thalassemia Antineoplastic chemotherapy induced pancytopenia Other drug-induced pancytopenia

13 Blood and Blood-Forming Organs Other pancytopenia Acquired hemophilia Antiphospholipid antibody with hemorrhagic disorder Other hemorrhagic disorder due to intrinsic circulating anticoagulants, antibodies, or inhibitors

14 Mental Disorders Dementia, unspecified, without behavioral disturbance Dementia, unspecified with behavioral disturbance

15 Nervous System and Sense Organs Corticobasal degeneration Brain death Lambert-Eaton syndrome, unspecified Lambert-Eaton syndrome in neoplastic disease Lambert-Eaton syndrome in other diseases classified elsewhere Borderline glaucoma, Open angle with borderline findings, high risk

16 Nervous System and Sense Organs Borderline glaucoma, Primary angle closure without glaucoma damage Glaucoma stage, unspecified Mild stage glaucoma Moderate stage glaucoma Severe stage glaucoma Indeterminate stage glaucoma Vitreomacular adhesion

17 Circulatory System Saddle embolus of pulmonary artery Hypertrophic obstructive cardiomyopathy Other hypertrophic cardiomyopathy Saddle embolus of abdominal aorta Other arterial embolism and thrombosis of abdominal aorta

18 Respiratory System Influenza due to identified novel Influenza A virus with pneumonia Influenza due to identified novel influenza A virus with other respiratory manifestations Influenza due to identified novel influenza A virus with other manifestations Respiratory conditions due to smoke inhalation Postoperative air leak Primary spontaneous pneumothorax

19 Respiratory System Secondary spontaneous pneumothorax Chronic pneumothorax Other air leak Other pneumothorax Idiopathic interstitial pneumonia, not otherwise specified Idiopathic pulmonary fibrosis Idiopathic non-specific interstitial pneumonitis Acute interstitial pneumonitis

20 Respiratory System Respiratory bronchiolitis interstitial lung disease Idiopathic lymphoid interstitial pneumonia Cryptogenic organizing pneumonia Desquamative interstitial pneumonia Lymphangioleiomyomatosis Adult pulmonary Langerhan cell histiocytosis 516.6X Interstitial lung disease of childhood Neuroendocrine cell hyperplasia of infancy

21 Respiratory System Pulmonary interstitial glycogenosis Surfactant mutations of the lung Alveolar capillary dysplasia with vein misalignment Other interstitial lung diseases of childhood Acute respiratory failure following trauma and surgery Other pulmonary insufficiency, not elsewhere classified, following trauma and surgery

22 Digestive System 539.X Complications of bariatric procedures 539.0X Complications of gastric band procedure Infection due to gastric band procedure Other complications of gastric band procedure 539.8X Complications of other bariatric procedure Infection due to other bariatric procedure Other complications of other bariatric procedure

23 Complications of Pregnancy, Childbirth, and the Puerperium Erosion of implanted vaginal mesh and other prosthetic materials to surrounding organ or tissue Exposure of implanted vaginal mesh and other prosthetic materials into vagina Inappropriate change in quantitative human chorionic gonadotropin (hcg) in early pregnancy Other abnormal products of conception 649.8X Onset (spontaneous) of labor after 37 completed weeks of gestation but before 39 completed weeks gestation, with delivery by (planned) cesarean section

24 Skin and Subcutaneous Tissue Pilar cyst Trichilemmal cyst

25 Congenital Anomalies Pulmonary artery coarctation and atresia Pulmonary arteriovenous malformation Other anomalies of pulmonary artery and pulmonary circulation

26 Symptoms, Signs, and Ill-Defined Conditions Solitary pulmonary nodule Other nonspecific abnormal finding of lung field Nonspecific reaction to tuberculin skin test without active tuberculosis Nonspecific reaction to cell mediated immunity measurement of gamma interferon antigen response without active tuberculosis

27 Injury and Poisoning Multiple closed pelvic fractures without disruption of pelvic circle Multiple open pelvic fractures without disruption of pelvic circle 996.8X Complications of transplanted Organ Stem cell Post procedural aspiration pneumonia Retained cholelithiasis following cholecystectomy Other digestive system complications

28 Injury and Poisoning Postoperative shock, unspecified Postoperative shock, cardiogenic Postoperative shock, septic Postoperative shock, other Bloodstream infection due to central venous catheter Local infection due to central venous catheter Acute infection following transfusion, infusion, or injection of blood and blood products

29 Injury and Poisoning Anaphylactic reaction due to administration of blood and blood products Anaphylactic reaction due to vaccination Anaphylactic reaction due to other serum Other serum reaction due to administration of blood and blood products Other serum reaction due to vaccination Other serum reaction

30 V Codes V12.21 Personal history, Gestational diabetes V12.29 Personal history, Other endocrine, metabolic and immunity disorders V12.55 Personal history, Pulmonary embolism V19.1X Family history, Other eye disorders V19.11 Family history, Glaucoma V19.19 Family history, Other specified eye disorder V23.42 Pregnancy with history of ectopic pregnancy V23.87 Pregnancy with inconclusive fetal viability

31 V Codes V54.82 Aftercare following implantation of joint prosthesis V58.68 Long term (current) use of bisphosphonates V79.2 Special screening for mental disorders and developmental handicaps, Intellectual disabilities V87.02 Contact with and (suspected) exposure to uranium V88.21 Acquired absence of hip joint V88.22 Acquired absence of knee joint V88.29 Acquired absence of other joint

32 E codes E000.2 External cause status, Volunteer activity

33 Evaluation and Management Definitions of Commonly Used Terms New and Established Patient Solely for the purpose of distinguishing between new and established patients, professional services are those face-toface services rendered by a physician and reported by a specific CPT code(s). A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. An established patient is one who has received professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. See Decision Tree.

34 Evaluation and Management Definitions of Commonly Used Terms New and Established Patient Cont. In the instance where a physician is on call for or covering for another physician, the patient s encounter will be classified as it would have been by the physician who is not available. No distinction is made between new and established patients in the emergency department, E/M services in the emergency department category may be reported for any new or established patient who presents for treatment in the emergency department.

35 Evaluation and Management Definitions of Commonly Used Terms New and Established Patient Cont. The decision tree on page 5 is provided to aid in determining whether to report the E/M service provided as a new or an established patient encounter.

36 Evaluation and Management Initial Observation Care Typical times have been added to the initial observation codes based on a crosswalk from the Hospital Inpatient Services codes.

37 Evaluation and Management Prolonged Service with Direct Patient Contact Codes are used when a physician or other qualified health care professional provides prolonger service involving direct patient contact that is provided beyond the usual service in either the inpatient or outpatient setting. Direct patient contact is face-to-face and includes additional non-face-to-face services on the patient s floor or unit in the hospital or nursing facility during the same session. This service is reported in addition to the designated evaluation and management services at any level and any other services provided at the same session as evaluation and management services. Appropriate codes should be selected for supplies provided or procedures performed in the care of the patient during this period.

38 Evaluation and Management Prolonged Service with Direct Patient Contact Codes are used to report the total duration of faceto-face time spent by a physician or other qualified health care professional on a given date providing prolonged service in the office or the outpatient setting, even if the time spent by the physician or other qualified health care professional on that date is not continuous. Codes are used to report the total duration of time spent by a physician or other qualified healthcare professional at the bedside and on the patient s floor or unit, in the hospital or nursing facility on a given date providing prolonged service to a patient, even if the time spent by the physician or other qualified health care professional on that date is not continuous.

39 Evaluation and Management Prolonged Service with Direct Patient Contact Code or is used to report the first hour of prolonged service on a given date, depending on the place of service. Either code should be used only once per date, even if the time spent by the physician or other qualified health care professional is not continuous on that date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported because the work involved is included in the total work of the evaluation and management codes.

40 Evaluation and Management Prolonged Service with Direct Patient Contact Code and is used to report each additional 30 minutes beyond the first hour, depending on the place of service. Either code may also be used to report the final minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately. The use of the time based add-on codes requires that the primary evaluation and management service have a typical or specified time published in the CPT codebook.

41 Evaluation and Management Prolonged Service without Direct Patient Contact and Codes and are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an evaluation and management service and is beyond the usual physician or other qualified health care professional service time.

42 Evaluation and Management Prolonged Service without Direct Patient Contact and This service is to be reported in relation to other physician or other qualified healthcare professional services, including evaluation and management services at any level. This prolonged service may be reported on a different date than the primary service to which it is related. For example, extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of the past records. However, it must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management. A typical time for primary service need not be established within the CPT code set.

43 Evaluation and Management Prolonged Service without Direct Patient Contact and Codes and are used to report the total duration on non-face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service, even if the time spent by the physician or other qualified health care professional on that date is not continuous. Code is used to report the first hour of prolonged service on a given date regardless of the place of service. It should be used only once per date. Prolonged service of less than 30 minutes total duration on a given date is not separately reported.

44 Evaluation and Management Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Pediatric Critical Care Patient Transport (for total body cooling of neonates, see 0260T, 0261T)

45 Evaluation and Management Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Inpatient Neonatal and Pediatric Critical Care , 99475, The pediatric and neonatal critical care codes include those procedures listed for the critical care codes (99291, 99292). In addition, the following procedures are also included (and are not separately reported by professionals, but may be reported by facilities) in the pediatric and neonatal critical care service codes ( , 99475, 99476) and the intensive care codes ( ):

46 Evaluation and Management Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Inpatient Neonatal and Pediatric Critical Care , 99475, Any services performed that are not included in these listings may be reported separately. Facilities may report the included services separately. Car Seat Evaluation ( ) When the critically ill neonate or pediatric patient improves and is transferred to a lower level of care, the transferring physician does not report a per day critical care service. Subsequent Hospital Care ( ) or Critical Care Services ( ) is reported, as appropriate based upon the condition of the neonate or child. The receiving physician reports a Subsequent Intensive Care ( ) or Subsequent Hospital Care ( ), as appropriate based upon the condition of the neonate or child.

47 Evaluation and Management Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services Initial and Continuing Intensive Care When a neonate or infant improves after the initial day and is transferred to a lower level of care, the transferring physician does not report a per day intensive care service, Subsequent Hospital Care ( ) is reported. When the neonate or infant becomes critically ill on a day when Initial or Subsequent Intensive Care Services have been performed and is transferred to a critical care level of care performed by a different physician, the transferring physician reports either the Critical Care Services performed ( ) or the Intensive Care Service performed, but not both. The receiving physician reports Subsequent Inpatient Neonatal or Pediatric Critical Care ( ).

48 Surgery Integumentary Debridement Wound debridements ( ) are reported by depth of tissue that is removed and by surface area of the wound. The services may be reported for injuries, infections, wounds and chronic ulcers. When performing debridement of a single wound, report depth using deepest level of tissue removed. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. For example: When bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer, report the work with a single code, When subcutaneous tissue is debrided from a 16 sq cm dehisced abdominal wound and a 10 sq cm thigh wound, report the work with for the first 20 sq cm and for the second 6 sq cm. If all four wounds are debrided on the same day, use modifier 59 with either 11042, or as appropriate.

49 Surgery Integumentary Introduction Deletions (11975 has been deleted. To report insertion of non-biodegradable drug delivery implant for contraception, use 11981) (11977 has been deleted. To report removal of implantable contraceptive capsules with subsequent insertion of non-biodegradable drug delivery implant, use and 11981)

50 Surgery Integumentary Repair (Closure) Instructions for listing services at time of wound repair: 2. When more than one classification of wounds is repaired, list the more complicated as the primary procedure and the less complicated as the secondary procedure, using modifier Involvement of nerves, blood vessels and tendons: Report under appropriate system (Nervous, Cardiovascular, Musculoskeletal) for repair of these structures. The repair of these associated wounds is included in the primary procedure unless it qualifies as a complex repair, in which case modifier 59 applies.

51 Surgery Integumentary Skin Replacement Surgery Skin replacement surgery consists of surgical preparation and topical placement of an autograft (including tissue cultured autograft) or skin substitute graft (ie, homograft, allograft, xenograft). The graft is anchored using the providers choice of fixation. When services are performed in the office, routine dressing supplies are not reported separately.

52 Surgery Integumentary Skin Replacement Surgery The following definition should be applied to those codes that reference 100 sq cm or 1% of body area of infants and children when determining the involvement of body size: The measurement of 100 sq cm is applicable to adults and children 10 years of age and older; and percentages of body surface area apply to infants and children younger than 10 years of age. The measurements apply to the size of the recipient area. Procedures involving wrist and/or ankle are ported with codes that include arm and leg descriptor.

53 Surgery Integumentary Skin Replacement Surgery When a primary procedure requires a skin substitute or skin autograft for definitive skin closure (eg, orbitectomy, radical mastectomy, deep tumor removal), use in conjunction with primary procedure. For biological implant for soft tissue reinforcement, use in conjunction with primary procedure. The supply of skin substitute graft(s) should be reported separately in conjunction with

54 Surgery Integumentary Skin Replacement Surgery Definitions Surgical preparation codes for skin replacement surgery describe the initial services related to preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy. In some cases, closure may be possible using adjacent tissue transfer ( ) or complex repair ( ). In all cases, appreciable nonviable tissue is removed to treat a burn, traumatic wound or a necrotizing infection. The clean wound bed may also be created by incisional release of a scar contracture resulting in a surface defect from separation of tissues.

55 Surgery Integumentary Skin Replacement Surgery Definitions The intent is to heal the wound by primary intention, or by the use of negative pressure wound therapy. Patient conditions may require the closure of application of graft, flap, or skin substitute to be delayed, but in all cases the intent is to include these treatments or negative pressure wound therapy to heal the wound. Do not report for removal of nonviable tissue/debris in a chronic wound (eg, venous or diabetic) when the wound is left to heal by secondary intention. See active wound management codes ( ) and debridement codes ( ) for this service. For necrotizing soft tissue infections in specific anatomic locations, see

56 Surgery Integumentary Skin Replacement Surgery Definitions Select appropriate code from based upon location and size of the resultant defect. For multiple wounds, sum the surface area of all wounds from all anatomic sites that are grouped together into the same code descriptor. For example, sum the surface area of all wounds on the trunk and arms. Do not sum wounds from different groupings of anatomic sites (eg, face and arms). Use or 15004, as appropriate, for excisions and incisional releases resulting in wounds up to and including 100 sq cm of surface area. Use or for each additional 100 sq cm or part thereof. For example: Surgical preparation of a 20 sq cm wound on the right hand and a 15 sq cm wound on the left hand would be reported with a single code,

57 Surgery Integumentary Skin Replacement Surgery Definitions Surgical preparation of a 75 sq cm wound on the right thigh and a 75 sq cm wound on the left thigh would be reported with for the first 100 sq cm and for the second 50 sq cm. If all four wounds required surgical preparation on the same day, use modifier 59 with 15002, and

58 Surgery Integumentary Skin Replacement Surgery Definitions Autografts/tissue cultured autografts include the harvest and/or application of an autologous skin graft. Repair of donor site requiring skin graft or local flaps is reported separately. Removal of current graft and/or simple cleansing of the wound is included, when performed. Do not report Debridement is considered a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.

59 Surgery Integumentary Skin Replacement Surgery Definitions Select the appropriate code from based upon type of autograft and location and size of defect. The measurements apply to the size of the recipient area. For multiple wounds, sum the surface area of all wounds from all anatomic sites that are grouped together into the same code descriptor. For example, sum the surface area of all wounds on the trunk and arms. Do not sum wounds from different groupings of anatomic sites (eg, face and arms).

60 Surgery Integumentary Skin Replacement Surgery Definitions Skin substitute grafts include non-autologous human skin (dermal or epidermal, cellular and accellular) grafts (eg, homograft, allograft), nonhuman skin substitute grafts (ei, xenograft), and biological products that form a sheet scaffolding for skin growth. These codes are not to be reported for application of non-graft wound dressings (eg, gel, ointment, foam, liquid) or injected skin substitutes. Removal of current graft and/or simple cleansing of the wound is included, when performed. Do not report Debridement is considered a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.

61 Surgery Integumentary Skin Replacement Surgery Definitions Select the appropriate code from based upon location and size of the defect. For multiple wounds, sum the surface area of all wounds from all anatomic sites that are grouped together into the same code descriptor. For example, sum the surface area of all wounds on the trunk and arms. Do not sum wounds from different groupings of anatomic sites (eg, face and arms)

62 Surgery Integumentary Skin Replacement Surgery Skin Substitute Grafts The supply of skin substitute graft(s) should be reported separately in conjunction with For biologic implant for soft tissue reinforcement, use in conjunction with code for primary procedure.

63 Surgery Integumentary Skin Replacement Surgery Skin Substitute Grafts Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure) Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area on infants and children each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

64 Surgery Integumentary Skin Replacement Surgery Skin Substitute Grafts Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure) Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area on infants and children each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

65 Surgery Integumentary Other Flaps and Grafts Implantation of biologic implant (eg, accellular dermal matrix) for soft tissue reinforcement (eg, breast, trunk) (List separately in addition to code for primary procedure)

66 Surgery Musculoskeletal System General Introduction or Removal Injection, enzyme (eg, collagenase), palmar facial cord (ie, Dupuytren s contracture) Back and Flank Arthrodesis Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar each additional interspace and segment (List separately in addition to code for primary procedure)

67 Surgery Musculoskeletal System Hands and Fingers Repair, Revision, and/or Reconstruction Manipulation, palmar fascial cord (ie, Dupuytren s cord), post enzyme injection (eg, collagenase), single cord

68 Surgery Musculoskeletal System Application of Casts and Strapping Lower Extremity Strapping-Any Age Application of multi-layer compression system; leg (below knee), including ankle and foot thigh and leg, including ankle and foot when performed upper arm and forearm upper arm, forearm, hand and fingers

69 Surgery Respiratory Lungs and Pleura Pleural cavity or lung biopsy procedures may be accomplished using a percutaneous, thoracoscopic (Video-Assisted Thoracoscopic Surgery [VATS]), or thoracotomy approach. They involve the removal of differing amounts of tissue for diagnosis. A biopsy may be performed using different techniques such as incision or wedge. Lung resection procedures include diagnostic and therapeutic procedures, including the removal of blebs, bullae, cysts, and benign or malignant tumors or lesions. These procedures may involve the removal of small portions of the lung or even an entire lung.

70 Surgery Respiratory Lungs and Pleura Additionally, lung resection procedures may require the removal of adjacent structures. Both diagnostic lung biopsies and therapeutic lung resections can be performed utilizing a wedge technique. However, a diagnostic biopsy of a lung nodule using a wedge technique requires only that a tissue sample be obtained without particular attention to resection margins. A therapeutic wedge resection requires attention to margins and complete resection even when the wedge resection is ultimately followed by a more extensive resection.

71 Surgery Respiratory Lungs and Pleura In the case of a wedge resection where intraoperative pathology consultation determines that a more extensive resection is required in the same anatomic location, it becomes classified as a diagnostic wedge resection (32507, 32668). When no more extensive resection is required, the same procedure is a therapeutic wedge resection (32505, 32666). Pleural or lung biopsies or diagnostic wedge resections should be reported using codes 32096, 32097, 32098, 32400, 32405, 32507, 32607, 32608, or The open or thoracoscopic (VATS) therapeutic resection of a lung mass or nodules via a wedge resection is reported using codes 32505, 32506, 32666, and

72 Surgery Respiratory Lungs and Pleura More extensive anatomic lung resection procedures, which can be performed with either thoracotomy or thoracoscopic (VATS) approaches, include: segmentectomy, lobectomy, bilobectomy, and pneumonectomy. When diagnostic biopsy(ies) of the lung are performed, regardless of the approach (ie, open or thoracoscopic [VATS]), or technique (eg, incisional resection, cautery resection, or stapled wedge), and the specimen is sent for intraoperative pathology consultation, and during that same operative session the surgeon uses these results to determine the extent of the necessary surgical resection that includes the anatomical location biopsied, only the most extensive procedure performed (eg, segmentectomy, lobectomy, thoracoscopic [VATS] lobectomy) should be reported.

73 Surgery Respiratory Lungs and Pleura The therapeutic wedge resection codes (32505, 32506, or 32667) should not be reported in addition to the more extensive lung procedure (eg, lobectomy) unless the therapeutic wedge resection was performed on a different lobe or on the contralateral lung, whether or not an intraoperative pathology consultation is used to determine the extent of lung resection. When a diagnostic wedge resection is followed by a more extensive procedure in the same anatomical location, report add-on codes or with the more extensive procedure(s). When a therapeutic wedge resection (32505, 32506, or 32667) is performed in a different lobe than the more extensive lung resection (eg, lobectomy), report the therapeutic wedge resection with modifier 59.

74 Surgery Respiratory Lungs and Pleura Incision Thoracotomy with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral Thoracotomy, with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral Thoracotomy, with biopsy(ies) of pleura

75 Surgery Respiratory Lungs and Pleura Removal Thoracotomy; with therapeutic wedge resection (eg, mass, nodule), initial with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure) with diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure)

76 Surgery Respiratory Lungs and Pleura Thoracoscopy (video-assisted thoracic surgery [VATS]) Thoracoscopy; with diagnostic biopsy(ies) of lung infiltrate(s) (eg, wedge, incisional), unilateral with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), unilateral with biopsy(ies) of pleura with therapeutic wedge resection (eg, mass, nodule), initial unilateral with therapeutic wedge resection (eg, mass or nodule), each additional resection, ipsilateral (List separately in addition to code for primary procedure)

77 Surgery Respiratory Lungs and Pleura Thoracoscopy (video-assisted thoracic surgery [VATS]) with diagnostic diagnostic wedge resection followed by anatomic lung resection (List separately in addition to code for primary procedure) with removal of a single lung segment (segmentectomy) with removal of two lobes (bilobectomy) with removal of lung (pneumonectomy) with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (LVRS), unilateral includes any pleural procedure, when performed with resection of thymus, unilateral or bilateral with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure)

78 Surgery Cardiology Heart and Pericardium Pacemaker or Pacing Cardioverter-Defibrillator Extensive changes to coding Guidelines. See CPT pages 169 through Insertion of pacemaker pulse generator only; with existing single lead # with existing multiple leads # Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system # dual lead system # multiple lead system

79 Surgery Cardiology Heart and Pericardium Pacemaker or Pacing Cardioverter-Defibrillator Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead # with existing dual leads # with existing multiple lead system # Removal of pacing cardioverter-defribillator pulse generator with replacement of pacing cardioverter-defibrillator pulse generator; single lead system # dual lead system # multiple lead system

80 Surgery Cardiology Arteries and Veins Vascular Injection Procedures Extensive new guidelines. See CPT pages 196 and Selective catheter placement (first order), main renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture and catheter placement(s), fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral bilateral 36253Superselective catheter placement (one or more second order or higher renal artery branches) renal artery and any accessory renal artery(s) for renal angiography, including arterial puncture, catheterization, fluoroscopy, contrast injection(s), image postprocessing, permanent recording of images, and radiological supervision and interpretation, including pressure gradient measurements when performed, and flush aortogram when performed; unilateral bilateral

81 Surgery Cardiology Hemic and Lymphatic Systems Bone Marrow or Stem Cell Services/Procedures Bone marrow harvesting for transplantation; allogeneic autologous

82 Surgery Gastroenterology Abdomen, Peritoneum, and Omentum Incision Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance with imaging guidance Peritoneal lavage, including imaging guidance when performed

83 Surgery Nervous System Spine and Spinal Cord Extensive new guidelines. See CPT pages Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System Destruction by Neurolytic Agent (eg, Chemical, Thermal, Electrical or Radiofrequency) # Destruction by neurolytic agent, paravertebral facet joint nerve(s) with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint # cervical or thoracic, each additional facet joint (List separately in addition to code for primary procedure) # lumbar or sacral, single facet joint # lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure)

84 Radiology Diagnostic Radiology (Diagnostic Imaging) Abdomen Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing Radiation Treatment Management Extensive new guidelines. See CPT page Intraoperative radiation treatment management

85 Radiology Nuclear Medicine Gastrointestinal System Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed Respiratory System Pulmonary ventilation imaging (eg, aerosol or gas) Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging Quantitative differential pulmonary perfusion, including imaging when performed Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed

86 Pathology Molecular Pathology Extensive new guidelines. See CPT pages 407 and new codes. Immunology Nuclear Matrix Protein 22 (NMP22), qualitative

87 Medicine Vaccines, Toxoids Influenza virus vaccine, split virus, preservative-free, for intradermal use Psychiatric Therapeutic Procedures Other Psychiatric Services or Procedures Therapeutic repetitive transcranial magnetic stimulation (TMS) treatment; initial, including cortical mapping, motor threshold determination, delivery and management subsequent motor threshold re-determination with delivery and management

88 Medicine Ophthalmology Special Ophthalmological Services Fitting of contact lens for treatment of ocular surface disease Fitting of contact lens for management of keratoconus, initial fitting Special Otorhinolaryngologic Services Evaluative and Therapeutic Services Evaluation of prescription of non-speech-generating augmentative and alternative communication device, face-toface with the patient; first hour # each additional 30 minutes (List separately in addition to code for primary procedure)

89 Medicine Noninvasive Vascular Diagnostic Studies Other Noninvasive Vascular Diagnostic Studies Unlisted noninvasive vascular diagnostic study

90 Medicine Pulmonary Pulmonary Diagnostic Testing and Therapies Extensive new guidelines. See CPT page Plethysmography for determination of lung volumes and, when performed, airway resistance Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes Airway resistance by impulse oscillometry Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure) Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes each additional full 30 minutes (List separately in addition to code for primary procedure)

91 Medicine Neurology and Neuromuscular Procedures Sleep Medicine Testing Extensive new guidelines. See CPT pages 507 and 508. Electromyography New guidelines. See CPT page 509. # Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited (List separately in addition to code for primary procedure) # complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels (List separately in addition to code for primary procedure) # Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s) done with nerve conduction, amplitude and latency/velocity study (List separately in addition to code for primary procedure)

92 Medicine Neurology and Neuromuscular Procedures Evoked Potentials and Reflex Tests # Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs

93 Medicine Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration Extensive new guidelines. See CPT pages 517 and 518.

94 Category II Codes 58 new Category II Codes for 2012

95 Category III Codes 31 new Category III Codes for 2012